Clinical Reasoning Cycle and Nursing Care: A Case Study Analysis

Running head: NURSING
NURSING
Name of the University
Author Note

NURSING
Introduction
Clinical reasoning cycle can be considered as an essential element of nursing care for
the provision of a client-centered care because it has the power to determine the outcome of
the patient care (Australian Learning and teaching cycle. 2018). Poor clinical reasoning skill
has been found to deliver accurate and satisfactory health care (Durning et al. 2013).
Drawing on the previous case study, Ms. Ness Ms Ness was brought to the Medical unit with
a chief complaint of exacerbation of COPD. She had a history of Type 2 diabetes for which
she was taking antidiabetic medications. On 17th of December 2018, she was about to be
discharge d as her assessments were found to be alright and she was found to be medically
stable; however, in the afternoon the student nurse conducted an OBS round and found that
Ms Ness looked more pale and clammy than the usual . In addition, she was anxious, weak
and agitated. The nurse did not examine the signs and symptoms presented by the patient as
these are common manifestations of COPD. In this regard, it was found that before breakfast,
Ms Ness’ BGL was significantly low for her. The nurse in the morning took the blood
glucose level of the patient; however, the nurse overlooked to interpret the reading and did
not take any patient cues. As such, the morning nurse gave the medication without realizing
that the patient BGL was low and the patient had a poor oral intake.
In this case study, I will discuss about two errors that I have encountered while caring
for Ms. Sweet Ness. One of the errors that has been identified is the unpacking principle and
the premature bias, while the entire clinical reasoning was taking place.

NURSING
Discussion
The nurse has made an error in the processing of the information is visible from the
fact that the nurse in the morning did not consider Ms. Ness low blood glucose level (5.3
mmol) before the administration of the antidiabetic drug 5.3 mmol of blood sugar level can
be considered much less in patients with T2D. The processing of the information recognizes
changes in the condition of the patient and failure to asses any changes in the patient
condition might lead to adverse condition (Bonds et al 2014). Premature closure is again a
diagnostic error that is caused in a decision making process, where a diagnosis is accepted
before it has been diagnosed fully (Saposnik et al. 2016). This error causes for a high
proportion of missed diagnosis. In many cases, the decisions are made too early and can be
linked to missed diagnosis (Norman et al. 2017). It is evident from the case study that
patient’s skin had become clammy and the patient was displaying weakness and agitation,
which was mistakenly considered as the signs and symptoms of COPD, but later on it was
found that it was due to the hypoglycemia. Furthermore, Errors in collecting the cues has
also been found in this clinical encounter. Unpacking principle is a type of clinical reasoning
error identified by Levett Jones that occurs on failure to collect all the relevant cues is
establishing a differential diagnosis that may result in significant possibilities being missed
(Australian Learning and teaching cycle. 2018). Considering Ms. Ness’ low blood glucose
level, the nurse did not go for further assessment or did not even as whether the patient had
her breakfast before giving any kind of antidiabetic medications. There are certain diabetic
medicines that should be taken with meals it increases insulin efficiency and to avoid the
gastrointestinal effects (Rates 2014). It can also be known from the case study that just before
commencing the discharge procedure, the nurse that Ms. Ness looked Pale and Clammy and
Pale than usual. Ms. Ness justified this with the reason that she skipped breakfast and dinner.